PruittHealth CLINICAL REIMBURSEMENT CONSULTANT - RN in Charlotte, North Carolina
Category : Clinical Services
Location/City : NC - Charlotte
Id : 23986
Title: CLINICAL REIMBURSEMENT CONSULTANT - RNLocation: Charlotte, NCPOSITION SUMMARY:Coordinates the training of regional and center partners and audits and provides recommendation for Process Improvement for the following areas: - The RAI Process, the Care Management Process, and the use of various supporting software applications to ensure an appropriate Level of Resident care and equitable and timely reimbursement of the care provided. - Utilization of skilled Medicare services. - Medicare RUG, Medicaid Case Mix CMI/ or Skilled Level of Care managementESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES:
Â· Knowledge of state and federal regulations, both clinical and financial as it relates to the RAI process and reimbursement systems.Â· Provides information and education to center and regional partners on the Importance and use of the RAI and Care Plan, Medicare PPS, and State Case Mix and Skilled Level of Care processes and their correlation to resident care and reimbursement.Â· Provides instruction on how to read, interpret and use the information contained in various states, federal, and company initiated and generated reports.Â· Provides expertise, consultation and guidance to appropriate partners to ensure MDS accuracy and adherence to company policy and procedures as well as state and federal regulations and guidelines based on information derived from audits and other available data.Â· Identifies trends and areas of improvement and ensures an appropriate PI plan is completed, through analysis of financial and clinical reports.Â· Maintains in-depth knowledge of the clinical software and billing system, the RAI process, and company initiated online support to help investigate and troubleshoot user-related software issues.Â· Interviews applicants for the Clinical Care Manager (CCM) and provides recommendations to the hiring authority.Â· Oversees and coordinates the process for a thorough and timely orientation for new CCMs.Â· Ensures current, new, and revised RAI/ PPS/ Case Mix information is distributed to appropriate partners in a timely manner.Â· Provides information to regional and corporate staff on the status of clinical and financial reimbursement.Â· Participates in national and state professional organizations that strengthen the company's position and knowledge of the RAI process, Case Mix and clinical software programs.Â· Adheres to and oversees communication of privacy guidelines relative to the confidentiality of resident's protected health information.LICENSURE, CERTIFICATION, EXPERIENCE AND EDUCATION REQUIREMENTS:Â· Bachelor's degree in Nursing from an accredited school.Â· Current, active license as a Registered Nurse or Licensed Practical Nurse; or Allied Health Professional in the State practicing.Â· Five-(5) year's health care management and experience in multi-facility, long-term care organizations preferred.Â· Three-(3) year's clinical responsibility and experience with RAI process required.Â· Travel expectation 80% Traveler's Travel PolicyWe offer a progressive benefits program that reflects our commitment to caring for our 16,000 partners:* Partner Referral Program â Earn cash for referring licensed and certified candidates* Employer paid profit sharing* Employer matching 401(k)* Paid Time Off (PTO) accruals beginning the first day of employment* Access to "Purchasing Power" financial health program after one year of employmentFor immediate consideration, please click the "Apply Now" at the top right of this screen.At PruittHealth, Committed to Caring isn't simply a tagline, it's the way we do business and it's ingrained in our culture. At PruittHealth, we don't hire employees â we welcome partners!Since its inception in 1969, PruittHealth has been a family-owned innovative organization committed to providing exceptional care across a wide spectrum of services including: skilled nursing care, assisted & independent living, home health care, end-of-life hospice care, rehabilitation, pharmacy/infusion services and more.
Today, the organization is the 14th largest skilled nursing provider in the United States, spans across the Southeast, touches 170 communities, cares for 24,000 patients daily, and is driven by 16,000 passionate partners.PruittHealth is an Equal Employment Opportunity employer and all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability or veteran status.